Provider Demographics
NPI:1902019607
Name:SANDERS, JEFFREY BRENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BRENT
Last Name:SANDERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 W. DEER VALLEY RD.
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382
Mailing Address - Country:US
Mailing Address - Phone:623-572-7505
Mailing Address - Fax:623-572-7602
Practice Address - Street 1:7505 W. DEER VALLEY RD.
Practice Address - Street 2:SUITE 130
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382
Practice Address - Country:US
Practice Address - Phone:623-572-7505
Practice Address - Fax:623-572-7602
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32081223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics